Access research and evaluation
Research into the access and availability of healthcare services in our communities.
District variations in rates of hospital admission
This project is a continuation of previous work on this topic. In 2008 a paper was published on changes in the level of hospital care over the last 15 years; it also described changes in variation across districts in that time. Further work analysing levels of surgery and variation between districts within a surgical specialty is planned. This will also look at the impact of private surgery and additional government funding for elective surgery on variation.
Funding
Health Services Research Centre
Researcher
Antony Raymont
Access to medicines
This HRC funded project is looking at inequities in access to medicines in the Gisborne region, 2007-2009. Data has been collected from pharmacies in the Gisborne region and is being compared with pharmaceutical data held by the New Zealand Health Information Service. The data are currently being collaged ready for analysis. Otago University is the lead university for this project.
Funding
Health Research Council of New Zealand
Researcher
Jackie Cumming
Access to services for vulnerable populations
A DHBNZ/HRC funded initiative conducting a stocktake of projects in New Zealand designed to improve access to services and an evaluation of particular projects with a view to encouraging other DHBs to use these systems.
CBG Health Ltd are the lead investigators. A review of the international literature on ways to improve access to primary care was completed in 2008. An intervention which will deliver education to the staff of primary care providers and allow outreach nurses to contact those who under-use services has been planned and will commence in January 2009.
Funding
DHBNZ / Health Research Council of New Zealand.
Researchers
Antony Raymont, Jackie Cumming
Surgical needs analysis
This project calculated the number of surgeons that will be required in New Zealand to 2026 based on population projections and on an estimate of current unmet surgical need. It also included a survey of all New Zealand surgeons concerning their activities and their working conditions. The projections were published in the NZ Medical Journal and informed recent proposals by the Minister of Health to increase the volume of elective surgery. The information on surgeons’ activities and working conditions, including resource limitations they face, will be published in the ANZ Journal of Surgery (March 2009).
Funding
Royal Australasian College of Surgeons
Researcher
Antony Raymont
Coronary Artery Bypass Graft Surgery—evaluation of the validity of the prioritisation score and the impact of waiting
This study is testing the predictive power of Clinical Priority Assessment Criteria (CPAC) scores (and components of scores), several serum bio-markers, total treadmill test times, and socioeconomic variables, and assesses the costs of waiting for care. In depth data has been collected on the experiences of around 150 New Zealanders in order to assess the impact of waiting for elective surgery on health and economic factors. The researchers are currently writing up the results from the research. In collaboration with the Universities of Auckland, Canterbury and Otago.
Funding
Health Research Council of New Zealand
Researchers
Jackie Cumming, Megan Pledger
Pathways to Care and Outcomes for Elective Surgery: A prospective cohort study
This study has followed for 18 months a cohort of patients considered for surgical referral by GPs. The study has identified patients receiving and not receiving surgery, exploring the reasons in each case, and auditing patients’ health care utilisation and health outcomes. All data on around 1600 patients has been collected and the researchers are currently writing up the results. In collaboration with the University of Otago.
Funding
Health Research Council of New Zealand
Researchers
Jackie Cumming, Antony Raymont, Megan Pledger
Equity, Variation and Convergence in Surgeons’ Clinical Judgements of Priority
This study documents the variability of general surgeons’ clinical judgements of priority for elective surgical patients at three hospitals in New Zealand. The study is investigating whether a structured feedback intervention, involving written feedback and peer discussion by surgeons of variable clinical judgements across their ranks, provokes a ‘convergence’ of priority judgements. It also assesses the impact, if any, on patients’ health related quality of life should convergence in priority judgements occur.
The first round of data on general surgery patients has been collected, the findings analysed and presented to participating hospital staff. The next phase of the research involves further feedback and collection of additional patient data to identify if decision making converges over time. During 2009, the emphasis was on developing and trialling an electronic system to feedback information on clinical priority assessments in clinics at Dunedin Hospital. In collaboration with the Universities of Auckland and Otago, and involving Auckland, Canterbury and Otago District Health Board services.
Funding
Health Research Council of New Zealand
Researchers
Jackie Cumming, Greg Martin
Access to Medicines
This HRC funded project is looking at inequities in access to medicines in the Gisborne region, 2007-2009. Data has been collected from pharmacies in the Gisborne region and is being compared with pharmaceutical data held by the New Zealand Health Information Service. The data have been collated and are now being analysed, with findings being written up for publication during 2010. Otago University is the lead university for this project.
Funding
Health Research Council of New Zealand
Researcher
Jackie Cumming
Access to Services for Vulnerable Populations
A DHBNZ/HRC funded initiative conducting a stocktake of projects in New Zealand designed to improve access to services and an evaluation of particular projects with a view to encouraging other DHBs to use these systems.
CBG Health Ltd are the lead investigators. A review of the international literature on ways to improve access to primary care was completed in 2008. An intervention which will deliver education to the staff of primary care providers and allow outreach nurses to contact those who under use services has been planned and commenced in January 2009. The trial will be completed in 2010. Findings are currently being written up for publication.
Funding
District Health Board New Zealand / Health Research Council of New Zealand
Researchers
Antony Raymont, Jackie Cumming
NHC report: Literature review on rural health
This project provided the National Health Committee with a review of local and international literature concerning rural health. The review included a framework for analysing rural access, appraised material on rural need, rural heath service supply, realised access to services by rural people, and discussed options for improved information to assist policy development.
Funding
National Health Committee, 2006
Researcher
John Fraser
Surgical needs analysis
An analysis of the future needs of the New Zealand population for surgery and for surgeons was commissioned by the Royal Australasian College of Surgeons. Data on current levels of surgery was projected out to 2026 using Statistics New Zealand population projections. A survey of surgeons was carried out to assess current and future workload. Projections and workload were combined to estimate the need for surgeons in the future. Variation in surgical rates were used to estimate the current level of unmet need for surgery. A report has been submitted to the College and work is underway on a paper for publication. It is hoped that the estimates will assist in planning surgical services and in the design of surgical training programmes.
Funding
Royal Australasian College of Surgeons, 2005-2006
Researchers
Antony Raymont, Jackie Cumming
District variations in rates of hospital admission
This project is a continuation of previous work on this topic. The intention is to identify areas with low (or high) rates, unjustified by population characteristics. These data will be fed back to policy makers for use in their priority setting to increase the fairness of the public system. Variation across districts is an international issue and has been ascribed to supply factors, population differences and practitioner style. Research in New Zealand is in a good position to shed light on these factors since the relationship between populations and hospital services is defined and total volume of public surgery is determined by contract but the mix of surgery, and the volume of private surgery, is determined by clinical decisions. Analyses are underway with results due in 2006.
Funding
Health Services Research Centre, 2005-2006.
Researchers
Antony Raymont, Jackie Cumming
Surgical needs analysis
This new project consists of an analysis of the future needs of the New Zealand population for surgery and surgeons. Data on current levels of surgery will be projected out to 2031 using Statistics New Zealand population projections. A survey of surgeons will assess current and future workload. Projections and workload will be combined to estimate the need for surgeons in the future. This information will assist in the planning of surgical training programmes as well as in hospital planning. Analyses are underway and a survey of surgeons will be completed in 2006.
Funding
Royal Australasian College of Surgeons, 2005-2006
Researchers
Antony Raymont, Jackie Cumming